The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study

  • Moon, Jee Youn (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Choi, Sang Sik (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Lee, Shin Young (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Lee, Mi Kyung (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kim, Jung Eun (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Lee, Ji Eun (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, So Hyun (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine)
  • Received : 2016.01.11
  • Accepted : 2016.03.22
  • Published : 2016.04.01
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Abstract

Background: Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug. The concomitant use of opioids and nefopam is believed to have many advantages over the administration of opioids alone for postoperative pain management. We conducted a randomized, double-blind study to determine the fentanyl-sparing effect of co-administration of nefopam with fentanyl for postoperative pain management via patient controlled analgesia (PCA). Methods: Ninety female patients who underwent laparoscopic total hysterectomy under general anesthesia were randomized into 3 groups, Group A, fentanyl $1,000{\mu}g$; Group B, fentanyl $500{\mu}g$ + nefopam 200 mg; and Group C, fentanyl $500{\mu}g$ + nefopam 400 mg, in a total volume of 100 ml PCA to be administered over the first 48 h postoperatively without basal infusion. The primary outcome was total fentanyl consumption during 48 h; secondary outcomes included pain scores and incidence of side effects. Results: Eighty-one patients were included in the analysis. The overall fentanyl-sparing effects of PCA with concomitant administration of nefopam during the first 48 h postoperatively were 54.5% in Group B and 48.9% group C. Fentanyl use was not significantly different between Groups B and C despite the difference in the nefopam dose. There were no differences among the three groups in terms of PCA-related side effects, although the overall sedation score of Group B was significantly lower than that of Group A. Conclusions: The concomitant administration of nefopam with fentanyl for postoperative pain management may allow reduction of fentanyl dose, thereby reducing the risk of opioid-related adverse effects.

Keywords

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